卵巢非特异性类固醇细胞瘤临床病理分析

目的探讨卵巢非特异性类固醇细胞瘤的临床病理特征及病理诊断。方法收集2例卵巢非特异性类固醇细胞瘤,进行组织学、免疫组化染色观察,并复习文献,讨论其临床、病理学特征、治疗和预后。结果肿瘤多发生于育龄妇女,临床最常见的症状是渐进性男性化,切面从浅黄色到棕红色,分叶状,界限清楚,质软,组织学上瘤细胞呈圆形或多边形,细胞质较丰富,嗜酸性颗粒状或透明空泡状,肿瘤间质为丰富窦状薄壁血管。免疫组化染色显示肿瘤细胞α-inhibin、Calretinin、MelanA、CD99(+)。此肿瘤的生物学行为与肿瘤大小、核异性程度、核分裂象多少、出血、坏死等有关。结论卵巢非特异性类固醇细胞瘤是少见的性索间质肿瘤,诊断及鉴别诊断需要结合临床表现、病理形态、免疫组化标记。     

卵巢无性细胞瘤4例分析

<正>无性细胞瘤是一种最常见的恶性原始生殖细胞肿瘤,但仅占卵巢所有恶性肿瘤的1%～2%,肿瘤细胞无特异性分化模式[1]。因临床较为罕见,为避免误诊、漏诊,本文回顾性分析4例无性细胞瘤的临床病理资料,同时复习相关文献,探讨其临床病理学特点、诊断与鉴别诊断要点及预后。1材料与方法1. 1材料收集安徽医科大学附属妇幼保健院2014—2018年病理诊断的卵巢无性细胞瘤4例,复     

血清β-HCG和AFP升高的单纯卵巢无性细胞瘤35例分析

目的：探讨患者血清β—HCG和AFP升高对部分卵巢无性细胞瘤诊断及预后判断的影响。方法：回顾性分析35例单纯卵巢无性细胞瘤患者血清中β—HCG和AFP水平,并行组织切片免疫组化染色。结果：5例患者血清中β-HCG和（或）AFP水平升高,组织切片β-HCG和（或）AFP染色阳性,手术后血清中β-HCG和（或）AFP水平均降至正常水平。结论：血清β-HCG和AFP升高可以作为部分卵巢无性细胞瘤诊断及预后判断的检测指标。     

卵巢无性细胞瘤临床病理分析并文献复习

目的:探讨卵巢无性细胞瘤的临床病理学特点及诊断要点。方法:对2例无性细胞瘤进行临床资料、病理形态学及免疫组化观察,并结合文献对其诊断及鉴别诊断进行探讨。结果:镜下肿瘤细胞被窄的纤维组织分隔呈巢状、岛屿状、条索状,纤维隔内有多少不等的淋巴细胞浸润,瘤细胞与核的大小外观呈明显一致性,胞质丰富淡染,核大圆形,核仁明显,核分裂像易见。免疫组化示肿瘤细胞PLAP呈不同程度阳性。结论:掌握无性细胞瘤的病理特点,提高对无性细胞瘤的认识,对避免误诊是至关重要的。     

卵巢无性细胞瘤CD117的表达及其鉴别诊断意义

[目的]探讨CD117在卵巢生殖细胞肿瘤中的表达及其在无性细胞瘤和非无性细胞瘤鉴别诊断中的价值.[方法]采用免疫组化SP法对51例卵巢恶性生殖细胞肿瘤作了CD117染色检测不同肿瘤中CD117表达的阳性率.[结果]8例无性细胞瘤CD117均阳性表达,阳性率为100.0%,主要为细胞膜表达;11例胚胎性癌中阳性表达2例,阳性率为18.2%,均为胞浆弱阳性表达.11例混合性生殖细胞瘤中阳性表达8例,阳性率为72.7%,均为肿瘤中无性细胞瘤成分呈阳性表达;其它类型的生殖细胞肿瘤无表达.[结论]CD117在卵巢无性细胞瘤细胞膜上有较为特异的表达,该表达对于鉴别无性细胞瘤和非无性细胞瘤有重要价值.     

卵巢恶性淋巴瘤6例临床病理分析

目的 探讨卵巢恶性淋巴瘤的临床病理特点和鉴别诊断.方法 分析6例卵巢恶性淋巴瘤的临床资料及组织病理学和免疫表型特点,按WHO(2001)淋巴造血组织肿瘤分类进行组织学分型.结果 6例患者平均年龄51岁,临床主要表现为腹痛和腹部包块.6例均诊断为弥漫性大B细胞性淋巴瘤,其组织学特点是瘤细胞弥漫分布,细胞大,核圆形或卵圆形,核膜厚,可见核仁.免疫组化:肿瘤细胞CD20、CD79a和MUM-1弥漫( ),CD3、CD43、MPO、CD117、PLAP和TdT均(-).结论 卵巢淋巴瘤极少见,确诊依赖组织学和免疫组化检测.该病需要和粒细胞肉瘤、无性细胞瘤、小细胞癌等鉴别.     

卵巢原发性非霍奇金恶性淋巴瘤的诊断与鉴别诊断

目的探讨卵巢原发性恶性淋巴瘤的诊断及卵巢原发性恶性肿瘤（颗粒细胞瘤、克鲁根伯瘤、未分化癌、无性细胞瘤及原始外胚叶肿瘤）鉴别诊断。方法应用组织病理学及免疫组织化学观察。结果免疫组织化学明确了卵巢原发性恶性淋巴瘤的诊断。结论原发性恶性淋巴瘤非常罕见，临床及病理诊断较困难，单凭形态学很难与其他小细胞肿瘤相鉴别，免疫组织化学标记有一定价值。     

类似卵巢性索肿瘤的子宫肿瘤2例临床病理观察

目的探讨类似卵巢性索肿瘤的子宫肿瘤的病理特点及生物学行为。方法收集临床资料、观察HE切片、行免疫组化检测,对病例进行诊断与鉴别诊断。结果 2例临床上分别表现为子宫内膜息肉及腺肌瘤。例1于息肉内见多样的形态改变,且细胞核级别高,部分细胞黄素化,免疫组化CD10、inhibin均(+);例2组织形态单一,于平滑肌束间见肿瘤细胞条索分布,细胞温和,可见核膜折叠或核沟,免疫组化CD10(-),inhibin散在弱(+)。结论类似卵巢性索肿瘤的子宫肿瘤诊断需注意结合形态及免疫组化标记,其分化与成熟度可能具有预后提示作用。     

卵巢类固醇细胞瘤8例临床病理分析

目的探讨卵巢类固醇细胞瘤的临床病理学特征。方法对8例卵巢非特异性类固醇细胞瘤进行HE及免疫组化染色并结合临床资料进行文献复习。结果肿瘤实性,界限清楚,肿瘤细胞呈巢、索状或弥漫性分布,细胞大,圆形或多角形,胞质丰富,泡沫状或嗜酸性颗粒状,部分肿瘤内含丰富毛细血管网和血窦。免疫组化,所有病例calretinin、CD99和vimentin(+),CK灶状(+),部分病例inhibin和melan-A(+)。诊断时需与妊娠黄体瘤、黄素化的颗粒细胞瘤和卵泡膜细胞瘤及透明细胞癌、血管性肿瘤、腺癌等鉴别。结论卵巢类固醇细胞瘤是一种罕见的卵巢肿瘤,结合临床资料、组织学形态及免疫组化有助于诊断。     

间皮素、D2-40和Glypican3在卵巢肿瘤中的鉴别诊断意义

卵巢癌是第三大妇科恶性肿瘤,卵巢透明细胞癌临床较少见,约占卵巢上皮性恶性肿瘤的5%-10%,但在妇科病理鉴别诊断中却占有相当比例。与卵巢透明细胞癌相关的鉴别诊断包括原始生殖细胞肿瘤（特别是卵黄囊瘤和无性细胞瘤）及卵巢浆液性囊腺癌,卵巢癌的分类不同与预后及临床处理大不相同,需要更加客观的指标用来鉴别卵巢癌。本文的目的旨在mesothelin、D2-40、Glypican3在卵巢癌诊断和鉴别诊断中的作用加以探讨。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.